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Advice from a Radiologist: Navigating Brain Lesions

Brain lesions are complex and can appear for a multitude of reasons.

Some occur suddenly, while others develop over a period of time. Medical imaging helps healthcare providers determine their origin, cause, and nature so that appropriate treatment – if necessary – can be pursued.

But while a CT or MRI provides clarity for doctors, the medical reports patients receive after getting their scans often include technical terms that can cause confusion and anxiety.

“I find that, more often than not, patients have a lot of questions about their reports that they don’t typically have the opportunity to ask their radiologist, “ says Dr. WIntermark, Chief of Neuroradiology at Stanford University and Second Opinion Radiologist for DocPanel.

In this exclusive interview, we sat down with Dr. Wintermark to explore the most common questions patients have about brain lesions and find out how a second opinion can help provide clarity for those navigating a diagnosis.

DocPanel is committed to making sure every patient receives excellent care. If you would like an expert second opinion on your medical imaging scan from Dr. Wintermark or one of our other neuroradiology subspecialists, you can learn more here.

What Is a Brain Lesion?

[DocPanel] What is a brain lesion?

[Dr. Wintermark]

A brain lesion refers to any type of abnormal tissue in or around the brain tissue.

[DocPanel] What are the different types of brain lesions and what causes them?

[Dr. Wintermark]

There is a wide array of brain lesions. Some are related to the normal aging process of the brain. Others are related to trauma, inflammation, or infection. Brain lesions also include vascular abnormalities and benign and malignant brain tumors.

Brain CTs and MRIs are often needed to elucidate the nature of brain lesions.

Common Appearances of Brain Lesions on Medical Scans

[DocPanel] What are some of the biggest indicators on a CT or MRI that reveal what type of brain lesion has been detected?

[Dr. Wintermark]

CT and MRI scans allow radiologists to identify the exact location of brain lesions. This enables us to see how they relate to the adjacent brain structures, often helping us to understand patients’ symptoms.

CT and MRI scans also show different feature sets that can help determine the type of brain lesion. Along with the clinical presentation and the other tests obtained, such as blood tests, a diagnosis can be made based on the combined analysis of all the information available.

[DocPanel] Are there any specific characteristics that indicate a brain lesion is benign? Malignant? How is this determined?

[Dr. Wintermark]

The first step when interpreting a CT or an MRI of the brain is to determine where the lesion is located compared to the brain tissue. Next, based on the imaging features, the nature of the brain lesion can usually be determined, as well as whether it is a benign or a malignant lesion. However, the distinction is frequently not straightforward and this requires the experience of a neuroradiologist.

With brain lesions, the location determines the symptoms rather than the lesion’s nature. But the nature of the lesions can influence how fast the symptoms come on, what the patient’s prognosis is, and what treatment options are available.

How to Navigate a Brain Lesion Diagnosis

[DocPanel] What advice do you have for patients who have been diagnosed with brain lesions?

[Dr. Wintermark]

My advice would be to have an open conversation with your physician to understand exactly the nature of the brain lesion, its prognosis, and what care options are available.

There are so many things people find on the internet that can be really overwhelming. I did a second opinion for a patient who, in doing online research, came to a place where he was extremely worried. In this case, his research brought him in the wrong direction. I was able to help him frame what he’d learned in a better way so that he could more accurately relate the information to his own brain lesion diagnosis. I was able to help him distinguish what was relevant and orient him in the right direction.

Second opinions are also an opportunity for me to interact with patients more closely, and directly address their questions and concerns in a more personal way compared to how standardized radiological reports are typically written.

[DocPanel] Is there anything patients should be aware of before beginning treatment?

[Dr. Wintermark]

Patients should develop a great relationship with their physician and understand their treatment options. The diagnosis will, of course, greatly influence treatment – so ensuring you have an accurate diagnosis is crucial.

Preventing Misdiagnosis of Brain Lesions

[DocPanel] What are some common pitfalls in imaging of brain lesions that patients should be aware of?

[Dr. Wintermark]

Brain imaging is complex and many lesions can look almost the same – while representing different entities. The radiologist typically works closely with the patient’s physicians to make sure the latter has the best information to make their care decisions with their patient.

Because brain lesions can be tricky, interpretation from a neuroradiologist with subspecialty training and experience is very important in avoiding potential pitfalls.

[DocPanel] How can patients help ensure they are not misdiagnosed?

[Dr. Wintermark]

The most important element in my mind is good communication with their physician. Patients should ask their doctors as many questions as they have, until they have all been answered.


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